Referral Forms

Use the search tool (below right) to quickly find the referral form you are looking for.

Please note: We encourage you to transition to using Ocean e-referrals for a faster, more secure, and streamlined process. By utilizing the electronic system, you can reduce errors and improve tracking of referrals.


Documents
Adult Psychiatry - Physician Referral
Subject: Referral Forms View Document

Additional Details
Title: Adult Psychiatry - Physician Referral
Date: July 17, 2015
Summary: Adult Psychiatry (Oshawa)- Physician Referral
Adult Psychiatry (Ajax Pickering) - Physician Referral
Subject: Referral Forms View Document

Additional Details
Title: Adult Psychiatry (Ajax Pickering) - Physician Referral
Date: November 24, 2020
Summary: Outpatient Mental Health Referral Form - Specific to Ajax Pickering
Breast Assessment Referral - Oshawa
Subject: Referral Forms View Document

Additional Details
Title: Breast Assessment Referral - Oshawa
Date: November 30, 2023
Summary: This form is for patients being referred to the Breast Assessment Program
Breast Assessment Referral form, Ajax-Pickering
Subject: Referral Forms View Document

Additional Details
Title: Breast Assessment Referral form, Ajax-Pickering
Date: May 3, 2018
Summary: 1438AP Interventional Breast Procedure Req.
Cardiac CT Requisition - Specific to Ajax Pickering
Subject: Referral Forms View Document

Additional Details
Title: Cardiac CT Requisition - Specific to Ajax Pickering
Date: October 3, 2017
Summary: Cardiac CT Requisition 2108AP
Cardiac Diagnostics Referral
Subject: Referral Forms View Document

Additional Details
Title: Cardiac Diagnostics Referral
Date: March 17, 2023
Summary: This two page document is for patients who wish to be referred to the Cardiac Diagnostics Program at Lakeridge Health.
Cardiac Rehabilitation Program Referral
Subject: Referral Forms View Document

Additional Details
Title: Cardiac Rehabilitation Program Referral
Date: January 11, 2018
Summary: This one page document is for patients who wish to be referred to the Cardiac Rehabilitation Program at Lakeridge Health
Cardio Respiratory Services Pulmonary Function Requisition
Subject: Referral Forms View Document

Additional Details
Title: Cardio Respiratory Services Pulmonary Function Requisition
Date: June 19, 2019
Summary: Cardio Respiratory Services Pulmonary Function Requisition
Central East Regional Cancer Program Referral
Subject: Referral Forms View Document

Additional Details
Title: Central East Regional Cancer Program Referral
Summary: Complete this form to refer a patient to the Durham Regional Cancer Centre/Central East Regional Cancer Program.
Central East Thoracic Clinic Diagnostic Assessment Program Referral
Subject: Referral Forms View Document

Additional Details
Title: Central East Thoracic Clinic Diagnostic Assessment Program Referral
Date: March 31, 2023
Summary: The Thoracic Clinic and DAP will provide patients in the Central East LHIN with timely access to an interdisciplinary team. Members of the team include: thoracic surgeon, radiologist, pathologist, nurse navigator (RN) and other health disciplines. The Nurse Navigator will facilitate the plan of care.
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